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This report provides recommendations for use of the newly licensed hepatitis A vaccines (HAVRIX, manufactured by SmithKline Beecham Biologicals, and VAQTA, manufactured by Merck & Company, Inc.) in persons > or = 2 years of age and updates previous recommendations for use of immune globulin (IG) for protection against hepatitis A (superseding MMWR 1990;39[No. RR-2]:1-5). For preexposure protection, hepatitis A vaccine can now be used instead of IG in many circumstances; for postexposure prophylaxis, the recommendations for IG use are unchanged.
The bivalent influenza vaccines for the 1977-1978 immunization period will contain inactivated influenza A and B viruses representing currently prevalent strains and will be available in "split-virus" and "whole-virus" preparations, which differ in side-effects and immunogenicity. Annual vaccination is recommended for adults and children of all ages with chronic diseases, especially diabetes mellitus or cardiac, pulmonary, or renal disease. Vaccination is also recommended for persons over age 65 years and persons in vital community services. Age-related doses are specified in a table, and side-effects and use in pregnancy are discussed in the text.
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These recommendations update information regarding the polysaccharide vaccine licensed in the United States for use against disease caused by Neisseria meningitidis serogroups A, C, Y, and W-135, as well as antimicrobial agents for chemoprophylaxis against meningococcal disease (superseding MMWR 1985;34:255-9). This report provides additional information regarding meningococcal vaccines and the addition of ciprofloxacin and ceftriaxone as acceptable alternatives to rifampin for chemoprophylaxis in selected populations.
Outbreaks of serogroup C meningococcal disease (SCMD) have been occurring more frequently in the United States since the early 1990s, and the use of vaccine to control these outbreaks has increased. These outbreaks are characterized by increased rates of disease among persons who may have a common organizational affiliation or who live in the same community. By using surveillance for SCMD and calculation of attack rates, public health officials can identify SCMD outbreaks and determine whether use of meningococcal vaccine is warranted. This report describes 10 steps for evaluation and management of suspected SCMD outbreaks. The principles described also apply to suspected outbreaks caused by meningococcal serogroups A, Y, and W-135. The effectiveness of mass chemoprophylaxis (administration of antibiotics to large populations) has not been demonstrated in most settings in which community and organizational outbreaks occur. However, in outbreaks involving small populations, administration of chemoprophylaxis to all persons within this group may be considered. The ability to validate some aspects of these recommendations is currently limited by incomplete reporting of serogroup information in most systems for meningococcal disease surveillance in the United States and by the relative rarity of SCMD and SCMD outbreaks.
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Concerns about the safety of whole-cell pertussis vaccines prompted development of acellular vaccines that are less likely to provoke adverse events because they contain purified antigenic components of Bordetella pertussis. Two diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccines--ACEL-IMUNE and Tripedia--have been licensed for several years, but (until recently) only for administration of the fourth and fifth doses in the series to children aged 15 months-6 years who previously had received three or more doses of diphtheria and tetanus toxoids and whole-cell pertussis (DTP) vaccine. Published reports indicate that, when administered to infants aged 2, 4, and 6 months, acellular pertussis vaccines are effective in preventing pertussis disease and associated with fewer local, systemic, and certain more serious adverse events than whole-cell pertussis vaccines. On the basis of these data, the Food and Drug Administration (FDA) has licensed three DTaP vaccines for use among children aged 6 weeks-6 years. Tripedia is now licensed for the initial four doses, and ACEL-IMUNE for all five doses of the diphtheria, tetanus and pertussis vaccination series. A third DtaP vaccine (Infanix) was licensed in January 1997 for the initial four doses of the series. Tripedia, ACEL-IMUNE, and Infanix are now recommended for routine vaccination of infants and young children, although whole-cell pertussis vaccines remain acceptable alternatives. Tripedia, ACEL-IMUNE, and Infanix are recommended for all remaining doses in the schedule for children who have started the vaccination series with one, two, three, or four doses of whole-cell pertussis vaccines. In September 1996, FDA licensed the use of TriHIBit (ActHIB reconstituted with Tripedia) for the fourth dose in the series of vaccinations against diphtheria, tetanus, pertussis, and Haemophilus influenzae type b disease.
These recommendations update information concerning the vaccine and antiviral agents available for controlling influenza during the 1997-98 influenza season (superseding MMWR 1996;45[No. RR-5]:1-24). The principal changes include information about a) the influenza virus strains included in the trivalent vaccine for 1997-98, b) the vaccination of pregnant and breastfeeding women, and c) side effects and adverse reactions.
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